Provider Demographics
NPI:1245532498
Name:HINES, JEFF W (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:W
Last Name:HINES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HIGHWAY 17 N
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-6024
Mailing Address - Country:US
Mailing Address - Phone:843-238-5628
Mailing Address - Fax:843-232-0320
Practice Address - Street 1:601 HIGHWAY 17 N
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-6024
Practice Address - Country:US
Practice Address - Phone:843-238-5628
Practice Address - Fax:843-232-0320
Is Sole Proprietor?:No
Enumeration Date:2010-11-20
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09046183500000X
SC14008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist